Mark Cuban went looking for an answer to a scary question: What happens if a healthy person on a high-deductible health plan has a $1 million medical emergency and the insurer refuses to pay?
He did not like what he found. In posts on X and LinkedIn on Oct. 3, 2026, the billionaire investor and co-founder of Mark Cuban Cost Plus Drug Co. warned people weighing a high-deductible plan to be careful, arguing that the appeals system “might just be rigged against you,” Moneywise reported.
His complaint centers on independent review organizations, the outside reviewers that make the final call on many denied claims. Cuban argued that their biggest customers are the large insurance companies whose decisions they review, which he called a conflict of interest.
Whether those reviewers lean toward insurers is hard to prove either way. What is documented is how often claims get denied and how rarely patients push back.
Insurers selling plans on HealthCare.gov denied 19% of in-network claims in 2024, according to a KFF analysis of federal data. Consumers appealed fewer than 1% of those denials. When they did, insurers upheld the denial 66% of the time, so roughly a third were not upheld at that first stage.
The data covers only HealthCare.gov plans, not employer coverage, but the lesson travels: A denial is often a starting point, not a final answer.
Fall open enrollment is when many workers will pick a plan for 2027, and the best time to learn the appeals process is before you need it.
1. Find out why the claim was denied
Start with the explanation of benefits or denial letter, which should state the reason. Many denials have nothing to do with whether you needed the care.
In the KFF data, 36% of denials were coded simply as “other,” 25% were administrative, 9% involved a missing prior authorization or referral and only 5% were based on medical necessity.
A wrong billing code or a missing form can often be fixed by asking your doctor’s office to correct and resubmit the claim.
2. File an internal appeal on time
If the problem is not a simple error, ask the insurer to reconsider. Under rules for most plans, you must file an internal appeal within 180 days of getting the denial notice, according to HealthCare.gov. For urgent care, the plan must decide your appeal within 72 hours, according to the U.S. Department of Labor.
Send your appeal in writing, keep copies of everything and note the date and the name of every person you speak with.
3. Bring your doctor into it
A letter from your physician explaining why the treatment was necessary, with records attached, is often the strongest piece of an appeal. Ask the office whether it has handled appeals with your insurer before. Many have, and they know what the reviewer will look for.
4. Ask for an external review
If the insurer still says no, you can usually request an external review, which is the step Cuban criticized. You generally have four months from the final denial to file, and an independent reviewer decides the case.
“Your insurer is required by law to accept the external reviewer’s decision,” HealthCare.gov says.
The federal process is free, and other processes can charge no more than $25. Your state insurance department can also help, and for employer plans, the U.S. Department of Labor’s benefits advisers take questions.
5. Pick your plan as if a denial could happen
A high-deductible plan can make sense for people who rarely see a doctor, especially paired with a health savings account. For 2027, you can contribute up to $4,500 to an HSA with self-only coverage or $9,000 with family coverage, according to the IRS.
To be HSA-eligible, a plan must have a deductible of at least $1,750 for self-only coverage or $3,500 for a family, and its in-network out-of-pocket maximum can be as high as $8,700 or $17,400.
Before you choose one, ask whether you could cover the full out-of-pocket maximum from savings if you needed to. If the answer is no, a plan with a higher premium and lower deductible may cost less in a bad year.
Employers are shifting more costs to workers for 2027, which makes the comparison worth running. Learn how major companies are cutting back on 2027 health benefits.
A denial is not the last word
Cuban’s critique of the review system may or may not lead anywhere in Washington. The numbers that matter to your budget are closer to home: most denials are never appealed, and a meaningful share of those that are do not stand.
If a claim is denied, read the letter, mark the deadline and ask.
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